Effect of Patient-Focused Clinical Pathway on Anxiety, Depression and Satisfaction of Patients With Coronary Artery Disease: A Quasi-Experimental Study

Abstract

Background:Coronary artery diseases (CAD) are associated with psychological problems such as anxiety and depression in patients. Thus, management of these problems can consider as an important intervention by health care workers, especially nurses.Objectives:The purpose of this study was to investigate the effectiveness of patient-focused clinical pathway on anxiety, depression and satisfaction of patients with CAD.Patients and Methods:In this quasi-experimental study, 138 patients suffering from CAD in a coronary care unit of a referral teaching hospital affiliated to Semnan University of Medical Sciences in Semnan, Iran, were recruited using a convenience sampling method. The participants were assigned to two groups: Clinical pathway (CP) and routine (RUT) care. The level of anxiety and depression of patients were measured in admission and discharge in both groups. Also, the level of patients’ satisfaction was measured at the time of discharge. Data were analyzed using descriptive and inferential statistics.Results:Prevalence rates of anxiety and depression in total of patients were 7.2% and 8.7%, respectively. In terms of anxiety, the mean of difference between pretest and posttest scores in the CP group (0.52 ± 1.39) was higher compared to the RUT group (-0.17 ± 1.69) and there was a significant difference between the two group (P = 0.009). In terms of depression, the mean of this difference in the CP group (0.75 ± 2.05) was higher compared to the RUT group (0.00 ± 1.08), as there was a significant difference between the two group (P = 0.024). Also, the mean of patients’ satisfaction scores in the CP group (3.69 ± 0.39) was higher compared to the RUT group (3.45 ± 0.47) and there was a significant difference between the two groups (P = 0.002).Conclusions:According to the positive effects of CP on patients with CADs, it can be considered as a useful, safe and simple instrument for the improvement of patients’ outcomes. Thus, the findings of this study can provide a new insight in patient care for clinical nurses.

Intensive Patients’ Education and Lifestyle Improving Program in CAD Patients

“…According to previous studies, psychosocial stress has been found to contribute more than other traditional risk factors, and it is vastly underdiagnosed and undertreated, even more so after procedures, suggesting that more attention should be given to depression and anxiety after myocardial infarction (Barth, Schumacher, & Herrmann-Lingen, 2004). On account of high risk of stroke, severe complications, or even sudden death, most CAD patients experience helplessness, hopelessness, or worthlessness, resulting in self-reproaches and grave fear, thereby directly increasing occurrences of anxiety and depression (Benjamin et al, 2018; Fakhr-Movahedi et al, 2015; Mozaffarian et al, 2016; Pelletier et al, 2015). Care intervention programs with one or two intervention measures have been broadly utilized in cardiovascular patients for the purposes of psychological management and prognosis improvement (Fakhr-Movahedi et al, 2015; Pedersen et al, 2015; Shen et al, 2018).…”

“…On account of high risk of stroke, severe complications, or even sudden death, most CAD patients experience helplessness, hopelessness, or worthlessness, resulting in self-reproaches and grave fear, thereby directly increasing occurrences of anxiety and depression (Benjamin et al, 2018; Fakhr-Movahedi et al, 2015; Mozaffarian et al, 2016; Pelletier et al, 2015). Care intervention programs with one or two intervention measures have been broadly utilized in cardiovascular patients for the purposes of psychological management and prognosis improvement (Fakhr-Movahedi et al, 2015; Pedersen et al, 2015; Shen et al, 2018). For instance, a previous study reveals that patients’ education for 5 days contributes to anxiety and depression level reductions in CAD patients by increasing the patients’ awareness of disease risk factors, disease progression, or therapeutic interventions (Fakhr-Movahedi et al, 2015).…”

“…Care intervention programs with one or two intervention measures have been broadly utilized in cardiovascular patients for the purposes of psychological management and prognosis improvement (Fakhr-Movahedi et al, 2015; Pedersen et al, 2015; Shen et al, 2018). For instance, a previous study reveals that patients’ education for 5 days contributes to anxiety and depression level reductions in CAD patients by increasing the patients’ awareness of disease risk factors, disease progression, or therapeutic interventions (Fakhr-Movahedi et al, 2015). Another clinical trial illustrates that emotional support by daily communication with patients and family during treatment effectively relieves anxiety or depression assessed by HADS-A/D score in cardiovascular patients undergoing percutaneous coronary intervention (Shen et al, 2018).…”

“…Coronary artery disease (CAD), the major cause of death in developed countries with a rapidly climbing prevalence in developing countries, results in an estimated 56 million deaths worldwide every year (Khera & Kathiresan, 2017; Watkins & Farrall, 2006). Most of the CAD patients not only suffer from physical discomfort but also present with huge psychological pressure (Fakhr-Movahedi, Soleimani, Ghazvininejad, Maher, & Ghorbani, 2015; Gu, Zhou, Zhang, & Cui, 2016; Pelletier et al, 2015). According to several previous studies, most patients who suffer from CAD are tormented in different degrees of psychological illnesses, including anxiety, depression, and epilepsy, among which anxiety and depression are the most frequent psychological problems which present with high incidences ranging from 27.8% to 77.1% and 24.8% to 50.0%, respectively, in CAD patients, nearly twice or thrice higher compared with healthy people (Najafipour et al, 2016; van Dijk et al, 2016).…”

“…Care intervention has been widely applied in patients with cardiovascular diseases, which plays a favorable role in the prognosis of patients through providing health education, increasing nurse–patient communication, or encouraging physical training to raise disease awareness and promote disease rehabilitation (Rahmati Najarkolaei, Ghaffarpasand, Gholami Fesharaki, & Jonaidi Jafari, 2015). However, most previous care intervention programs in patients with cardiovascular diseases merely include one or at most two intervention measures and the intensity of intervention is relatively moderate (Ehrlich et al, 2016; Fakhr-Movahedi et al, 2015; Rahmati Najarkolaei et al, 2015), and little is known about the comprehensive effect of multicare interventions under intensive setting in CAD patients. Hence, we designed the intensive patients’ education and lifestyle improving program (IPEL), which consisted of patients’ education, emotional support, and lifestyle improvement, to investigate the effect of IPEL on anxiety, depression, and overall survival (OS) in CAD patients complicated with anxiety and depression.…”